The Future of Pharmacy in Relation to the Modern Development of Medicine
By William G. Toplis
Proceedings of Pennsylvania Pharmaceutical Association.
The year Eighteen Hundred and Eighty-one is destined to become known in medical and pharmaceutical history as the beginning of the most revolutionary epoch in all of the experience of those branches of endeavor.
That year brought forth a discovery whose importance is not yet generally recognized. Not alone is it concerned with medicine and pharmacy, but it has performed a most important service in engineering projects of world-wide importance. It may be truthfully said that this discovery and those it led up to, made possible the building of the Panama Canal.
It was a most important factor in bringing victory to Japan and defeat to Russia.
It is banishing pestilence from its breeding places everywhere, and no department of life, either animal or vegetable, is beyond its influence. It has placed the practice of medicine upon a scientific basis, and inaugurated the era of preventive medicine. The day of curative measures, with which we are most familiar, is passing. In most of the cities and large communities of the world, Public Hygiene has become a very important department of government. Observe our own city of Philadelphia; we have there the largest water purification plant in existence. Its effect, in that city is to reduce the number of typhoid fever cases 80 per cent. of the former total, and perhaps 100 per cent. of the water borne typhoid, peculiar to the Philadelphia water supply. A case of typhoid fever commonly runs three months. In money it is worth from fifty to one hundred dollars to the attending physician, perhaps half of that to the druggist.
A similar change has taken place concerning diphtheria. Anti-toxin and treatment are supplied to the patient at the expense of the communities in by far the greater number of cases.
Smallpox is practically unknown, for similar reasons.
Bacterins as prophylactic measures against typhoid, and a number of other diseases, are coming into increased usefulness.
Chemo Therapy. The latest advance has done astounding things. With one treatment of 606, Salvarsan, specific disease disappears to return no more. At least it seems so at this early date.
Much is promised from the same source in the eradication of cancer.
Leprosy, incurable, from remote antiquity, seems about to succumb to the new enlightenment.
The extermination of tuberculosis is within hailing distance. And so on through the whole catalogue of ills that plagued the people, unrestrained, less than 30 years ago.
The transcendental discovery of Dr. Koch, that has made possible all of these wonders, and many others beside, and others yet to come, is the simple fact that microscopic organisms grow in pure culture, upon a piece of boiled potato. This is the corner-stone upon which has been built the whole science of modern Bacteriology. With these facts confronting us and others of like nature to follow, we naturally turn to inquire what effect these changes are likely to exert upon the practice of pharmacy.
Every pharmacist has observed the greatly increased development of the commercial side of the drug business as compared with its scientific side, which rather seems to be accorded a secondary place in the conduct of its affairs, regardless of the fact that this feature is the one that gives it character, and the only one that distinguishes it from ordinary merchandising.
Thirty years ago the physicians whom we knew were high-minded, dignified gentlemen, who held the ethics of their profession in such esteem that they scorned to violate them. We could not imagine any of those, passing out a handful of tablets to an office patient for a fifty-cent fee. And yet the man of today who practices medicine under such conditions is to be condemned no more than his predecessors are to be condemned, because each of them is a product of the conditions of his day. Truly the change is to be deplored and the remedy is not yet ready. Thus we have a dreary spectacle, the most noble calling on God’s green foot-stool, degraded, through its commercial side, into a mad competition for existence. There are some other causes, beside those noted, that contribute to the same effect, such as increased numbers of individuals practicing both medicine and pharmacy. The later causes, however, are self-limiting and not necessarily fatal to the calling as a business proposition, whereas, with preventive measures well established, it is plain to all that both the practice of medicine and pharmacy as now conducted, will come to their end.
This does not mean that both doctors and druggists will disappear completely, but it certainly means that a new order of things is upon the threshold.
This is the year Nineteen-Hundred and Thirteen.
Between the years 1922 and 1932 we may expect to have established a National Board of Health, with a chief officer in the cabinet and an organization similar to that of the Army, in which every physician and every pharmacist will be an officer of the United States Government. Those physicians, under the new order, who remain in the office awaiting the call of the sick will be comparatively few in number. The remainder will be out in the broad domain of practical Hygiene. Every factory, farm, field, forest, stream, mines, and what not, will then come under the watchful eye of this new Army which, with all of the wisdom of science, will guard the health of the country, if anything, more zealously than it is guarded against foreign foes. Every occupational disease will be banished, every case of communicable disease will be promptly isolated.
The men who are to perform this service will be the doctors and druggists of today who survive at that time, together with those who shall be hereafter graduated in those professions; not that all of these men are at present fitted for this work, but their training and experience make them the most available.
They will, however, be subjected to periodic examinations that shall determine their advance and pay, and each one will gravitate into the place that best suits his capacity.
The pay of these men will be suitable to the dignity of their calling, certainly not less than that of a lieutenant in the United States Army.
Under this new order the people will receive their medicine and medical treatment upon the same plan that they now receive their public school education.
To the incredulous, it may be said that the people of Philadelphia alone spend annually fifteen millions of dollars for medical treatment and medicine. Under the new system the cost would be less than half of that sum, and the people will receive better attention than at present.
Schools of medicine and pharmacy will be government institutions, as are West Point and Annapolis, and their various laboratories will be the main centres from which the operations of this Hygienic Army shall be directed.
To the incredulous, again, it may be said, these conditions are coming, not because they are being sought, nor even desired, but they will be thrust upon us through the force of economic necessity.